Cardiopulmonary Bypass In Minimally Invasive Cardiac Surgery With Endoscopic Assistance: A Single Institution Experience
Ngoc Thanh Le, The Binh Nguyen, Tran Thuy Nguyen, Ngoc Minh Le, Anh Tien Do, Cong Huu Nguyen.
Cardiovascular Center, E - Hospital, Hanoi, Viet Nam.
Objective: Cardiopulmonary bypass (CPB) in minimally invasive cardiac surgery (MICS) is a complex technique. This study aimed at evaluating initial experiences of a center applying extracorporeal circulation technique to such type of surgery. Subjects and Methods: This is a retrospective study conducted on 839 patients who underwent MICS from 5/2013 to 7/2019 at E hospital's Cardiovascular Center. The patients were divided into two groups, group 1 included 216 patients with direct arterial cannula placement (from 5/2013 to 12/2015), group 2 of 623 patients with arterial cannula was set up indirectly in the common femoral artery through an artificial vessel (from 01/2016 to 7/2019). The procedure of placing intravenous cannula was the same for both groups (SVC and IVC cannula were placed through the right IJV and femoral vein with Seldinger technique). Negative pressure suction was used to support venous route. Myocardium was protected with Custodiol HTK fluid. Results: The CPB time was 163.02 ± 63.97 minutes, the aortic clamp time was 90.75 ± 64.85 minutes. There was 74.2% of cases, in which artery was pumped through artificial circuit. There was 4.3% of cases, in which the artery was converted into two arteries when the pump pressure was over 240mmHg. The rate of vascular complications of group 1 was 1.3% (femoral artery perforation, Arteriovenous Fistula, femoral artery stenosis), there was no vascular complication identified in group 2. There was 0.59% of patients with postoperative thigh or leg congestion in group 2. The overall death rate was 1.4%, with no difference between the two groups. Conclusion: CBP in MICS is a safe and effective technique, and is able to be carried out with current equipment. The strategies in CBP must be changed in order to meet with increasing development of MICS
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